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  • Case Study
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Esomeprazole-induced hyperchromograninemia in the absence of concomitant hypergastrinemia

Nature Reviews Gastroenterology & Hepatology volume 7, pages 642–646 (2010)Cite this article

Subjects

Abstract

Background A 37-year-old female, who had a neuroendocrine pancreatic neoplasm, underwent duodeno-cephalo-pancreatectomy. In the 2 years following surgery, she had normal levels of serum chromogranin A (CgA), gastrin and other tumor markers. About 3 years after surgery, owing to the onset of reflux-like dyspeptic symptoms, the patient started treatment with the PPI esomeprazole. During PPI treatment, the patient's serum CgA level rose to more than three times the upper limit of normal, although her gastrin levels remained in the normal range. These findings were interpreted as being suggestive of neuroendocrine tumor relapse.

Investigations Thoraco-abdominal CT, In111-octreotide total body scan, CT of sella turcica, Tc99m-sestamibi neck scan, mutational analysis of chromosome 11q13 (site of multiple endocrine neoplasia type 1 [MEN1] gene). Discontinuation of, and rechallenge with, esomeprazole.

Diagnosis Esomeprazole-induced hyperchromograninemia in the absence of elevated levels of fasting serum gastrin.

Management Discontinuation of acid-suppressive treatment and continuation of oncologic follow-up.

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Figure 1: An abdominal CT scan of the patient.
Figure 2: Blood chromogranin A and gastrin levels during the follow-up period.

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Acknowledgements

Part of the information described in this Case Study was presented in abstract form at the 34th National Congress of the Italian Society of Pharmacology, October 14–17th 2009, Rimini, Italy (Gori, G., Spinelli, G., Spinelli, C., Tuccori, M., Blandizzi, C. & Del Tacca, M. “High levels of chromogranin A and serotonin associated with esomeprazole treatment in a patient on follow-up after surgery for pancreatic neuro-endocrine tumor”). Written consent for publication was obtained from the patient. L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Division of Pharmacology and Chemotherapy, Department of Internal Medicine, University of Pisa, via Roma, 55-56126, Pisa, Italy

    Giovanni Gori, Giacomo Spinelli, Marco Tuccori, Corrado Blandizzi & Mario Del Tacca

  2. Department of Surgery, University of Pisa, via Roma, 55-56126, Pisa, Italy

    Claudio Spinelli

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  1. Giovanni Gori
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Contributions

G. Spinelli and C. Spinelli researched the data for the article. G. Gori, M. Tuccori, C Blandizzi and M. Del Tacca provided a substantial contribution to discussions of the content. G. Gori, M. Tuccori and C. Blandizzi contributed to writing the article. All of the authors reviewed and/or edited the manuscript before submission.

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Correspondence to Mario Del Tacca.

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Gori, G., Spinelli, G., Spinelli, C. et al. Esomeprazole-induced hyperchromograninemia in the absence of concomitant hypergastrinemia. Nat Rev Gastroenterol Hepatol 7, 642–646 (2010). https://doi.org/10.1038/nrgastro.2010.152

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